Adaptation of the virtual assessment of mentalizing ability and evaluation of its utility and psychometric properties in Chinese individuals on the schizophrenia spectrum

Schizophrenia is associated with impairments in theory of mind (ToM), the ability to understand and attribute mental states. However, the nature of the deficits across ToM subconstructs (viz., first- and second-order cognitive ToM, and first- and second-order affective ToM) remains unclear, partly due to assessment issues. The current study aimed to first adapt an ecologically valid ToM assessment tool, namely, the Virtual Assessment of Mentalizing Ability (VAMA), for use among healthy Chinese individuals (Study 1). We then compared 39 schizophrenia patients with 37 controls, and 48 individuals with high social anhedonia (SA) with 54 individuals with low SA (Study 2) using the adapted version of VAMA and Yoni Task. Results of Study 1 showed that the adapted VAMA demonstrated acceptable reliability (item-total correlation and test-retest reliability for total score, r = 0.731, p_FDR < 0.01) and construct validity (main effect of Order and Type). In Study 2, schizophrenia patients performed significantly worse than controls, making more "hypermentalizing" and "no mentalizing" ToM errors. Moreover, hypermentalizing error in the patient group was found to be significantly associated with their negative symptoms (r = 0.388, p_FDR < 0.05). Interestingly, the VAMA results differed from those of the Yoni Task, possibly due to differences in task complexity. Finally, individuals with high SA showed impairments in second-order cognitive ToM compared to the controls. Overall, our findings suggest that the VAMA can be adapted for use in China, and is sensitive to ToM impairments in clinical and at-risk groups. Limitations on the psychometric properties were discussed.